SGLT2 inhibitors beneficial in Chinese patients with type 2 diabetes

A Singapore study has reported good real-world experience with sodium-glucose co-transporter-2 (SGLT2) inhibitors, which are well tolerated and effective at improving blood sugar and lowering complications risk.

“However, such benefits were mostly observed in patients of Chinese ethnicity,” according to the investigators.

In an analysis of 67,556 type 2 diabetes (T2D) patients managed in the public healthcare setting in Singapore, those who were initiated on SGLT2 inhibitors were more likely to achieve glycaemic control target (HbA1c <7 percent) than those treated with dipeptidyl peptidase-4 (DPP4) inhibitors (40.8 percent vs 37.5 percent; risk ratio [RR], 1.09, 95 percent confidence interval [CI], 1.04–1.14). This was true for Chinese patients (RR, 1.09, 95 percent CI, 1.03–1.16) but not for Indian and Malay patients. [J Diabetes Metab Disord 2022;21:521-555]

SGLT2 inhibitors also conferred greater protection against the risk of hypoglycaemia (RR, 0.69, 95 percent CI, 0.59–0.82) and urinary tract infection (RR, 0.52, 95 percent CI, 0.43–0.63) compared with DPP4 inhibitors. There was no significant between-treatment difference in the risk of diabetic ketoacidosis (DKA).

“These [safety] results were also observed across all ethnic groups except in patients of Malay ethnicity. The risk of DKA was significantly reduced in this ethnic group while no significant difference was observed in the occurrence of hypoglycaemia hospitalizations with SGLT2 inhibitor initiation,” the investigators pointed out.

Finally, fewer hospitalizations and deaths up to 1 year after treatment initiation occurred with SGLT2 vs DPP4 inhibitors. The SGLT2 group had 12–72-percent lower any-cause and cause-specific hospitalizations and had 34-percent reduced risk of all-cause death (RR, 0.66, 95 percent CI, 0.51–0.85).

The beneficial effect of SGLT2 inhibitors on the risk of hospitalizations and deaths was similarly observed in patients of Chinese and Indian ethnicity, except the risk of all-cause death was not statistically significant in the latter. In patients of Malay ethnicity, only hospitalization risk for diabetes-related kidney complications was significantly reduced with SGLT2 inhibitors.

“Our study also estimated that the reduced risk of hospitalizations associated with SGLT2 inhibitors would translate to cumulative savings of more than SGD 50 million and 1,261 deaths avoided over 10 years. Although the use of newer drugs such as SGLT2 inhibitors to improve glycaemic control would increase spending, these costs were offset by savings in the longer term from lower rates of co-morbidities,” the investigators pointed out.

“This is the first national real-world study in Singapore that evaluated the potential impact of ethnicity on the effects of SGLT2 inhibitors and DPP4 inhibitors,” they said, adding that in light of the present data, “future studies should consider ethnicity as a key factor in overall disease management and the risk of developing T2DM-related complications.”

For the study, the investigators performed propensity score matching to balance baseline characteristics between the treatment groups to minimize bias. The cohort consisted of 15,207 patients each in the SGLT2 and DPP4 groups. The average age was 56.8 years, and about half of the population were men and 60.5 percent were of Chinese ethnicity.